Ukutyhila i-24h ye-Ambulatory Blood Pressure Monitor
I. Intshayelelo ye-24h Ambulatory Blood Pressure Monitor
I-24h ye-ambulatory monitor ye-blood monitor sisixhobo esihlala silinganisa uxinzelelo lwegazi kwixesha leeyure ezingama-24. Ibalulekile kuvavanyo loxinzelelo lwegazi ngenxa yezizathu ezininzi. Okokuqala, ibonelela ngembono ebanzi ngakumbi yeepateni zoxinzelelo lwegazi lomntu imini yonke nobusuku. Ngokungafaniyo nabajongi boxinzelelo begazi bemveli abathatha kuphela umlinganiso wesnapshot, i-ambulatory monitor ibamba utshintsho loxinzelelo lwegazi ngexesha lemisebenzi eyahlukeneyo, amaxesha okuphumla, kunye nokulala.
Ngokomzekelo, uphando lubonisa ukuba malunga nomntu omdala omnye kwabathathu unoxinzelelo lwegazi oluphezulu. Imonitha ye-24h ye-ambulatory yoxinzelelo lwegazi inokunceda ukufumanisa uxinzelelo lwegazi olunokuthi luphoswe yimilinganiselo yamathuba athile. Iyakwazi nokuchonga 'i-white coat hypertension,' apho uxinzelelo lwegazi lomntu luphakanyiswe kuphela kwimeko yeklinikhi ngenxa yoxinzelelo.
Ezi gadi zidla ngokuba nesixhobo esincinci, esiphathwayo esincanyathiselwe kumzimba wesigulana. Inecuff evuthelayo ngamaxesha aqhelekileyo ukulinganisa uxinzelelo lwegazi. Ezinye iimodeli eziphambili, njengemonitha yoxinzelelo lwegazi engenazingcingo, zibonelela ngokulula kunye nokusebenziseka ngokulula.
Ukubaluleka kwe-24h ye-ambulatory esweni loxinzelelo lwegazi kukukwazi ukubonelela ngolwazi oluxabisekileyo lokuxilonga nokulawula uxinzelelo lwegazi. Ngokulandelela uxinzelelo lwegazi kwixesha elide, ababoneleli bezempilo banokwenza izigqibo ezichanekileyo zonyango kunye nokulungelelanisa amayeza njengoko kufuneka. Oku kunokukhokelela ekulawuleni ngcono uxinzelelo lwegazi kunye nokunciphisa umngcipheko weengxaki ezinxulumene noxinzelelo lwegazi oluphezulu, njengesifo senhliziyo kunye nesifo sohlangothi.
II. Izinto eziluncedo zokuHlola
(a) Uvavanyo oluchanekileyo
I-24h ye-ambulatory ye-monitor ye-blood pressure monitor inika uvavanyo oluchanekileyo loxinzelelo lwegazi xa kuthelekiswa neendlela zendabuko. Ihlala ilinganisa uxinzelelo lwegazi ngamaxesha aqhelekileyo imini nobusuku, ithatha ukuguquguquka okunokuthi kuphoswe yimilinganiselo yamathuba athile. Ngokomzekelo, uphando lubonisa ukuba aba balindi banokubona ukuhluka kwexesha elifutshane okubangelwa yimiba efana noxinzelelo, ukuzivocavoca kunye nokulala. Olu lwazi lubanzi lubonelela ngomfanekiso ochanekileyo weendlela zoxinzelelo lwegazi lomntu.
(b) Ukufunyanwa kweepateni ezingaqhelekanga
Imonitha ikwasebenza kakhulu ekubhaqeni iipateni zoxinzelelo lwegazi olungaqhelekanga. Iyakwazi ukuchonga i-non-dipping, riser, kunye neepateni zediphu ezigqithisileyo. Iipateni zokungadibi, apho uxinzelelo lwegazi lwasebusuku lunganciphi njengoko kulindelekile, lunokuba luphawu lokunyuka kwengozi ye-cardiovascular. Imonitha inokukubona oku kwaye yazise ababoneleli bezempilo ukuba bathathe amanyathelo afanelekileyo. Ngokufanayo, iipateni zokunyuka, apho uxinzelelo lwegazi lwasebusuku luphezulu kunoxinzelelo lwegazi lwemini, kunye neepatheni zedipper ezigqithisileyo, apho uxinzelelo lwegazi lwasebusuku lwehla kakhulu kunesiqhelo, nalo lunokubonwa. Ngokwezifundo, malunga ne-25% yezigulane ezinoxinzelelo lwegazi oluphambili kunye ne-50% -80% yezigulane ezine-refractory primary hypertension zingabonisa ezi pateni zingaqhelekanga. Ukufunyaniswa kwezi patheni kubalulekile ukuze kufunyanwe kwangethuba kunye nokulawulwa koxinzelelo lwegazi, njengoko kunokunceda ukuthintela iingxaki ezifana nesifo sentliziyo kunye nestroke.
III. Ingaba isebenza kanjani
Imonitha yoxinzelelo lwegazi ye-24h ye-ambulatory isebenza ngokudityaniswa kobuchwepheshe obuphambili kunye noyilo olusebenziseka lula. Isixhobo sokuhlola sidla ngokuba nesixhobo esincinci, esiphathwayo esincanyathiselwe kumzimba wesigulana. Esi sixhobo sixhotyiswe ngecuff ethi ivuthe ngamaxesha athile ukulinganisa uxinzelelo lwegazi.
Indlela yokusebenza iqala ngenzwa kwi-cuff ibona uxinzelelo kwi-artery yesigulane. Njengoko i-cuff inflates, ifaka uxinzelelo kwingalo, kwaye inzwa ilinganisa utshintsho kuxinzelelo. Imonitha ke isebenzisa i-algorithms ukubala amaxabiso e-systolic kunye ne-diastolic yoxinzelelo lwegazi.
Eminye imifuziselo ephucukileyo, enjengeemonitha zoxinzelelo lwegazi ezingenazingcingo, zisebenzisa iBluetooth okanye obunye ubuchwepheshe obungenazingcingo ukuhambisa idatha kwi-app ephathwayo okanye kwikhompyuter. Oku kuvumela ukubeka iliso lula kunye nohlalutyo lwedatha yoxinzelelo lwegazi.
Imonitha icwangciselwe ukuthatha imilinganiselo ngamaxesha aqhelekileyo imini nobusuku. Umzekelo, inokulinganisa uxinzelelo lwegazi rhoqo kwi-15 ukuya kwimizuzu engama-30. Olu qwalaselo oluqhubekayo lunika umfanekiso obanzi weendlela zoxinzelelo lwegazi lwesigulane kwisithuba seeyure ezingama-24.
Idatha erekhodwe ngumhloli igcinwe kwimemori yayo okanye idluliselwe kwisiseko sedatha ephakathi ukuze kuhlalutywe ngakumbi. Ababoneleli bezempilo banokuphinda baphonononge idatha kwaye benze uxilongo oluchanekileyo kunye nezigqibo zonyango.
Ukuqukumbela, i-24h i-ambulatory monitor ye-blood monitor isebenza ngokusebenzisa i-sensor eziphambili kunye ne-algorithms ukulinganisa ngokuqhubekayo uxinzelelo lwegazi kunye nokubonelela ngedatha ebalulekileyo kubaboneleli bezempilo.
IV. Usetyenziso
(a) Ukuxilongwa koxinzelelo lwegazi
Imonitha yoxinzelelo lwegazi ye-24h idlala indima ebalulekileyo ekuxilongeni iintlobo ezahlukeneyo zoxinzelelo lwegazi. Umzekelo, inokunceda ekuchongeni uxinzelelo loxinzelelo lwegazi ebusuku, oluhlala lungahoywa ngemilinganiselo yesiqhelo yoxinzelelo lwegazi. Ngokophando, malunga ne-10% ukuya kwi-20% yabantu abane-hypertension banoxinzelelo lwegazi ebusuku. Imonitha inokubona ukuba uxinzelelo lwegazi lomntu lunyukile na ebusuku, nokuba lubonakala luqhelekile na emini.
Ikwanokuxilonga i-hypertension yasebusuku ekwanti, apho uxinzelelo lwegazi ebusuku luphezulu kodwa uxinzelelo lwegazi lwasemini lukwimida eqhelekileyo. Le yimeko engumceli mngeni ngokukodwa ukubhaqa ngaphandle kokubeka iliso rhoqo. I-24h i-ambulatory monitor ye-blood pressure monitor inika idatha ebalulekileyo kubaboneleli bezempilo ukuba baxilonge ngokuchanekileyo kwaye balawule le meko.
Ukongeza, i-monitor inokunceda ukwahlula phakathi koxinzelelo lwegazi olumhlophe kunye noxinzelelo lokwenyani. Uxinzelelo lwegazi olumhlophe olumhlophe lwenzeka xa uxinzelelo lwegazi lomntu luphakanyisiwe kuphela kwimeko yeklinikhi ngenxa yoxinzelelo. Ngokulinganisa uxinzelelo lwegazi kwixesha le-24-iyure, i-monitor inokugqiba ukuba uxinzelelo lwegazi oluphakamileyo luhambelana okanye lusabela nje kwimeko yeklinikhi.
(b) Ukubeka iliso kwiFanelo loNyango
Imonitha yoxinzelelo lwegazi ye-24h sisixhobo esibalulekileyo sokuvavanya ukusebenza konyango lwe-antihypertensive. Ngokujonga ngokuqhubekayo uxinzelelo lwegazi, kunokubonisa ukuba amayeza amiselweyo okanye utshintsho lwendlela yokuphila ngokwenene luthoba uxinzelelo lwegazi ngokuhamba kwexesha.
Umzekelo, ukuba isigulana sikwiyeza le-antihypertensive, umntu obeka iliso unokubonelela ngedatha malunga nendlela elisebenza ngayo iyeza imini nobusuku. Ukuba uxinzelelo lwegazi luhlala luphezulu nangona unyango, ababoneleli bezempilo banokuhlengahlengisa idosi okanye batshintshe iyeza.
Ngaphezu koko, i-monitor inokunceda ukufumanisa ukuba ukuguqulwa kwendlela yokuphila njengokutshintsha kokutya, ukuzivocavoca, kunye nokunciphisa uxinzelelo kunempembelelo kuxinzelelo lwegazi. Ngokuthelekisa ukufundwa koxinzelelo lwegazi ngaphambi nangemva kokuphumeza olu tshintsho, ababoneleli bezempilo banokuhlola ukuphumelela kokungenelela.
Ekugqibeleni, i-24h i-ambulatory monitor ye-blood pressure monitor inezicelo ezibalulekileyo ekuxilongeni uxinzelelo lwegazi kunye nokubeka iliso ekusebenzeni kwonyango. Izakhono zayo zokubeka iliso eziqhubekayo zibonelela ngengqiqo ebalulekileyo kubaboneleli bezempilo ukuba benze izigqibo ezinolwazi kunye nokuphucula iziphumo zesigulane.
V. Ulawulo lwe-Hypertension yasebusuku
(a) Ukuchongwa
Imonitha yoxinzelelo lwegazi ye-24h ibalulekile ekuchongeni uxinzelelo lwegazi ebusuku. Ngokwezikhokelo, uxinzelelo lwegazi ebusuku luchazwa njengoxinzelelo lwegazi lwe-systolic ebusuku oluyi-≥120 mmHg kunye/okanye uxinzelelo lwegazi lwe-diastolic lwe-≥70 mmHg. Imonitha ngokuqhubekayo ilinganisa uxinzelelo lwegazi kulo lonke ixesha leeyure ezingama-24, kubandakanywa ngexesha lokulala. Oku kuvumela ababoneleli bezempilo ukuba babone ngokuchanekileyo ukuba isigulane siye saphakamisa uxinzelelo lwegazi ebusuku. Umzekelo, ukuba ufundo lwesigulana lubonisa uxinzelelo lwegazi oluhlala luhleli ngexesha lasebusuku elirekhodwe ngumhloli, oko kunokuba luphawu olucacileyo loxinzelelo lwegazi ebusuku.
(b) IziCwangciso zonyango
Kukho iindlela ezininzi zonyango loxinzelelo lwegazi ebusuku. Okokuqala, ukuguqulwa kwendlela yokuphila kudlala indima ebalulekileyo. Ukutya okunesodium kunye ne-potassium ephantsi kunokuncedisa ukunciphisa uxinzelelo lwegazi. Uphando lubonisa ukuba ukunciphisa i-sodium intake kunokukhokelela ekwehleni okukhulu koxinzelelo lwegazi. Ukongezelela, ukuphucula umgangatho wokulala kubalulekile. Izigulane kufuneka zicetyiswe ukuba zigcine ishedyuli yokulala rhoqo kunye nokujongana naluphi na ukuphazamiseka kokulala okanye ukuvuswa rhoqo. Ukunciphisa umzimba kunye nokuzilolonga rhoqo kunokuba luncedo. Uphononongo lubonise ukuba ukulahlekelwa nokuba ngumlinganiselo omncinci wobunzima kunokunciphisa uxinzelelo lwegazi.
Unyango lwe-Pharmacological yenye inketho. Amayeza asebenza ixesha elide antihypertensive ahlala enconyelwa njengoko anokubonelela ngolawulo loxinzelelo lwegazi oluqhubekayo imini nobusuku. Ngokomzekelo, i-calcium channel blockers, i-ACE inhibitors, kunye ne-ARBs zisetyenziswa ngokuqhelekileyo. Unyango oludityanisiweyo kunye namachiza amaninzi lunokuba yimfuneko kwezinye iimeko ukulawula ngokufanelekileyo uxinzelelo lwasebusuku.
Ukongezelela, ukunyanga iimeko ezisisiseko ezifaka isandla kwi-hypertension ebusuku kubalulekile. Ngokomzekelo, ukuba umguli une- obstructive sleep apnea syndrome (OSAS), ukunyanga le meko kunokunceda ukunciphisa uxinzelelo lwegazi. Ukulawula isifo sezintso esinganyangekiyo, isifo seswekile, kunye nezinye iingxaki ezinokuthi zibe nempembelelo entle kuxinzelelo loxinzelelo olukhulu ebusuku.
Okokugqibela, ukubeka iliso rhoqo kunye ne-24h ye-ambulatory esweni loxinzelelo lwegazi kubalulekile ukuvavanya ukusebenza konyango. Uhlengahlengiso lunokwenziwa ngokusekelwe kwidatha ebekwe iliso ukuqinisekisa ulawulo olululo loxinzelelo lwegazi.
